Surgical correction of post-DALK ametropia
XIV SICSSO Congress
Augusto PocobelliRome, Italy
Lecce 25-27 giugno 2015
Rome, Italy
PLOS ONE January 29, 2015
The Cochrane Library 2014, Issue 7
The Cochrane Library 2014, Issue 7
IN OUR CASE SERIES WE NOTED KERATOMETRIC STABILITY IN OUR CASE SERIES WE NOTED KERATOMETRIC STABILITY
AFTER AT LEAST 1 YEAR FROM SUTURE REMOVAL
IT WAS NECESSARY TO SELECT PATIENTS
FOR POST DALK AMETROPIA CORRECTION
SURGICAL CORRECTION IN
POST DALKAMETROPIA
CATARACT CLEAR LENS
PHACOEMULSIFICATION
WITH TORIC IOL IMPLANTATION
POSTERIOR CHAMBER
PHAKIC INTRAOCULAR LENS
IMPLANTATION
J Cataract Refract Surg 2014
26 eyes were included. Mean age was 57.1 years at the time of cataract surgery
Previous keratoplasty was penetrating (84.6%) or deep anterior lamellar (15.4%)
Keratoconus (73.1%) was the major indication for keratoplasty.
The mean IOL cylinder power was 6.85 + 3.02 diopters (D).
Both mean refractive spherical equivalent and refractive astigmatism decreased
significantlysignificantly
Significant improvement in the mean uncorrected distance visual acuity (UDVA) and in
the mean corrected distance visual acuity (CDVA)
Postoperatively, the UDVA and CDVA were 20/40 or better in 61.5% of eyes and 92.3%
of eyes, respectively.
In 2014 we started a prospective study on PHACOEMULSIFICATION with
TORIC IOL implantation in patients undergone a DALK procedure
INDICATION FOR DALK WAS KERATOCONUS
seven eyes of seven patients
MEAN FOLLOW-UP TIME AFTER PHACOEMULSIFICATION WAS
TIME BETWEEN SUTURE REMOVAL AND CATARACT EXTRACTION WAS AT LEAST 1 YEAR
6,71m +2,98
ALL PATIENT HAD FIL 611 T Customized Toric iol
MEAN FINAL ASTIGMATISM WAS 4,43D + 1,10 and SPHERICAL EQUIVALENT 7,57D + 7,75
6,33±±±± 2,76 D
ALL PATIENT HAD FIL 611 T Customized Toric iol
IMPLANTATION FROM THE SAME SURGEON
FIL 611 T Customized toric IOL
• Optic Diameter 6 mm
• Total Diameter 11.80 mm
• CCI 2.4 mm
• Material: foldable acrilate with 25% H2O• Material: foldable acrilate with 25% H2O
• Real axis tecnology
0,63
3,14
4,434,43
5,43
1,43
1,00
2,00
3,00
4,00
5,00
6,00
UCVA BCVA Cil
Pre Op.
Post Op.
-7,57
-0,43
-8,00 -7,00 -6,00 -5,00 -4,00 -3,00 -2,00 -1,00 0,00
Spherical Equivalent
Post Op.
Pre Op.
MEAN REFRACTIVE SPHERICAL EQUIVALENT WAS
MEAN REFRACTIVE ASTIGMATISM WAS
-7,57D +7,75
4,43D + 1,10 1,43D + 1,59
-0,43D +0,92
PRE POST
0,00
-8,00 -7,00 -6,00 -5,00 -4,00 -3,00 -2,00 -1,00 0,00
MEAN BEST CORRECTED VISUAL ACUITY (BCVA) WAS 3,14/10 +1,35
3/50 +4/50
5,43/10 +2,37
4,43/10 +2,23/10MEAN UNCORRECTED VISUAL ACUITY (UDVA) WAS
ENDOTHELIAL CELL COUNT WAS2020±±±±235
cell/mm2
1959±±±±170
cell/mm2
ICL
� Foldable plate-design / foot-plates
� Behind the iris / sulcus located
� Made of collamer
� Many designs possible with lathe� Many designs possible with lathe
� Wide range of prescriptions
� Removable/exchangable
� Excellent optical perfomance
(material, design,position)centralFlow technology
J Cataract Refract Surg 2009
PZ
PZ N. C. , MALE, 29 YEARS OLD OD>>OS KERATOCONUS
OD DALK JUL 2102 : BCVA WAS 1/10 ECD 2250 cells/mm2
OD SUTURE REMOVAL JUN 2013 : BCVA WAS 7/10 (-11sf = -0,75cil)
OD ICL IMPLANTATION AUG 2014 : UBVA WAS 8/10 at 15 days control
PZ
PRE OP3 MONTHS6 MONTHS
9 MONTHS
9/10ECD 2125 cells/mm2
IN CONCLUSION
INTRAOCULAR TORIC IOL IMPLANTATION
IS A VIABLE TREATMENT FOR
STABLE POST DALK AMETROPIA IN PRESENCE OF CATARACT
INTRAOCULAR TORIC IOL IMPLANTATION
IS A VIABLE TREATMENT FOR
STABLE POST DALK AMETROPIA IN PRESENCE OF CATARACTSTABLE POST DALK AMETROPIA IN PRESENCE OF CATARACTSTABLE POST DALK AMETROPIA IN PRESENCE OF CATARACT
IN YOUNGER PATIENTS FOR WHOM
CORNEAL REFRACTIVE SURGERY IS CONTROINDICATED
INTRAOCULAR PHAKIC IOL IMPLANTATION
IS A SAFE AND EFFECTIVE TREATMENT
IN YOUNGER PATIENTS FOR WHOM
CORNEAL REFRACTIVE SURGERY IS CONTROINDICATED
INTRAOCULAR PHAKIC IOL IMPLANTATION
IS A SAFE AND EFFECTIVE TREATMENT
DALK REMAINS A SAFE PROCEDURE AND ALLOWS A DEFINITIVE CORRECTION OF THE
RESULTING AMETROPIA